Article

Management of the fractured edentulous atrophic mandible

Tehran University of Medical Sciences, Dental Research Center, Keshavarz Boulevard, Ghods Street, Tehran, Iran, 14147.
Cochrane database of systematic reviews (Online) (Impact Factor: 5.94). 02/2007; DOI: 10.1002/14651858.CD006087.pub2
Source: PubMed

ABSTRACT Fractures of the atrophic and edentulous (toothless) mandible (lower jaw) are fairly common in elderly people. Atrophy and weakening tend to occur as a result of reduced vascularity and decreased blood flow. Treatment options for reduction and fixation include closed and open techniques, with the degree of atrophy having a significant influence on the type of treatment. Many methods have been proposed for treating fractures of the atrophic mandible but there is still some uncertainty as to which method has the most successful outcomes.
The objective of this review was to provide reliable evidence regarding the effectiveness of any interventions either open or closed that can be used in the management of fractured edentulous atrophic mandibles.
We searched the Cochrane Oral Health Group Trials Register; the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2005, Issue 4); MEDLINE from 1966 and EMBASE from 1980, both to 30th January 2006. Last search was done in January 2006.
Randomised controlled trials involving people over 55 years of age with fractures in the symphysis, parasymphysis, body, angle, ramus, condyle, and coronoid process of atrophic edentulous mandibles in which the fracture was a result of trauma, implant insertion or due to pathological fracture. Any studies that compared methods of management (open or closed reduction or fixation) were to be included.
Screening of eligible studies was conducted in duplicate and independently by two review authors. Results were to be expressed as random-effects models using mean differences for continuous outcomes and risk ratios for dichotomous outcomes with 95% confidence intervals. Heterogeneity was to be investigated including both clinical and methodological factors.
No eligible randomised controlled trials were identified.
This review illustrates that there is currently inadequate evidence for the effectiveness of a single approach, either open or closed, in the management of fractured atrophic edentulous mandibles and that until high level evidence is available treatment decisions should continue to be based on clinician's prior experience. This absence of evidence may in part reflect a certain lack of clarity and the apparent diversity and lack of reliability in some of the traditional and normative predictors of successful outcomes.

5 Followers
 · 
234 Views
  • [Show abstract] [Hide abstract]
    ABSTRACT: Treating edentulous mandibular fracture is difficult in elderly patients due to compromised medical condition of the patient and various contraindications for the surgical approach. The complication rate of infection or malunion is higher compared to fractures in younger, dentulous patients. For such conditions, ‘Gunning splint’ is a better option as it provides close reduction and stabilization of mandibular fracture, thus improving the prognosis.
    The Journal of Indian Prosthodontic Society 12/2014; DOI:10.1007/s13191-013-0294-2
  • [Show abstract] [Hide abstract]
    ABSTRACT: Management of mandibular condylar fractures remains a source of ongoing controversy. While some condylar fractures can be managed non-surgically, recognition of fracture patterns that require surgical intervention and selection of an appropriate operative procedure are paramount to success in treating these injuries.The objective of this review is to appraise the current evidence regarding the effectiveness of interventions that are used in the management of fractures of the mandibular condyle.
    British Journal of Oral and Maxillofacial Surgery 11/2009; 48(7):520-6. DOI:10.1016/j.bjoms.2009.10.010 · 1.13 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Transmucosal fixation is a new strategy for the treatment of edentulous mandibular fractures using external fixation principles within the oral cavity. The component parts of this technique are not new. External fixation, locking plates and transmucosal implants represent the foundations of this technique; the authors' development has been to bring these established methods together as a transmucosal intra oral locking plate fixation technique. The first eight patients treated with this technique have achieved bony union, they have no long-term sensory deficit and all patients were able to eat a soft diet with minimal discomfort the day after surgery. The first five of eight patients on long-term review showed bony union confirmed radiographically. For the remainder and subsequent patients, radiographs have not been scheduled at review, in the absence of symptoms.
    International Journal of Oral and Maxillofacial Surgery 12/2010; 40(5):549-52. DOI:10.1016/j.ijom.2010.10.027 · 1.36 Impact Factor